Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome.

OBJECTIVE: To assess the outcome of pregnancies complicated by kyphoscoliosis in modern obstetric and orthopedic care. METHODS: A total of 22 kyphoscoliotic patients with 34 pregnancies were identified from 46,828 pregnancies between 1998 and 2009. Their obstetric records and associated orthopedic problem were studied. RESULTS: The incidence of kyphoscoliosis complicating pregnancy was 0.072%. The mean age of the patients in their index pregnancy was 28.4 years (range 23-35), mean height 130 cm (range 125-138). The cause of kyphoscoliosis included idiopathic (majority), poliomyelitis and traumatic injury. Only 1 of the patient had previous spinal surgery. The cesarean rate was very high and none had any significant cardiorespiratory problem during anesthesia. There was no maternal or perinatal mortality. CONCLUSIONS: The high maternal and perinatal risks associated with kyphoscoliosis reported earlier no longer exist.

Cervicovaginal HCG and cervical length for prediction of preterm delivery in asymptomatic women at high risk for preterm delivery.

OBJECTIVE: To predict the risk of preterm birth (<37 weeks) or early preterm birth (<34 weeks) by cervicovaginal HCG and cervical length measured between 24-28 weeks of gestation in asymptomatic women at high risk for preterm birth. METHODS: This study was conducted in the departments' of Obstetrics & Gynaecology and Immunopathology of the Postgraduate Institute of Medical Education and Research, Chandigarh, India. In 75 pregnant women at high risk for preterm birth because of prior one on more preterm births due to spontaneous labour or ruptured membranes, cervicovaginal HCG and cervical length (by TVS) were measured between 24-28 weeks of gestation. These parameters were correlated individually and in combination for prediction of preterm birth. RESULTS: Of the 75 women, 20 (26.7%) delivered <37 weeks and 6 (8%) delivered <34 weeks. To predict delivery <37 weeks, cervical length <2.95 cm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 75%, 80.1%, 71.4% and 90.7% respectively, and cervicovaginal HCG >4.75 mIU/ml had a sensitivity, specificity, PPV, and NPV of 70%, 61.81%, 40% and 85% respectively. To predict delivery <34 weeks, cervical length <2.65 cm had a sensitivity, specificity, PPV, and NPV of 50%, 85.50%, 23.08% and 95.16% respectively; and cervicovaginal HCG >14 mIU/ml had a sensitivity, specificity, PPV and NPV of 83.3%, 85.5%, 33.3% and 98.3% respectively. Cervical length was superior to predict delivery <37 weeks, whereas HCG was superior to predict delivery <34 weeks. Their combination was superior to predict preterm birth both <37 weeks or <34 weeks, than either parameter used alone. CONCLUSION: In high risk asymptomatic women, increased cervicovaginal HCG and reduced cervical length and between 24 to 28 weeks of gestation increased the risk of preterm delivery.